What is Treatment?

Many of us know someone with a drinking or drug problem who has simply stopped using. Perhaps they just swore it off, or have successfully cut down, or have found their way into an AA or NA meeting without professional help. They can point to their lives being better and their improvement is usually apparent to others as well. These people might also be proud that they were able to accomplish this without needing treatment.

On the other hand, we may know someone who has been to rehab multiple times and still has not maintained stable sobriety. Such situations create a cynical view of the entire treatment enterprise, and there is substantial rumor that such treatment "doesn't work", that recovery rates are terrible, or that these cases are "hopeless".

Given these poles, why do we need treatment?

Some people simply have a more difficult time achieving sobriety than others. Whether this is due to the severity of the illness, psychological problems, deeply ingrained habits, social variables, personality characteristics, or unknown factors, simple recovery is just too difficult to accomplish. For people who seem to be stuck, outside assistance is usually needed.

Here, too, negative stereotypes abound. For many people, the image of treatment involves humiliation, petty punishments, boot-camp-like conditions and such. It is true that some programs have operated like that, although those programs are in a distinct minority nowadays. The value of coercion has been recognized to be minimal. While some may benefit from such a strict program, the vast majority of people need help which is more empathic and motivational than confrontational. In fact, one of the most consistent research findings is that therapist empathy is the strongest predictor of outcome.

Similarly, in many minds "going to rehab" is a prerequisite for recovery. Certainly, there are some who require that level of intensive treatment, and a separation from a dangerous environment, to get sober and learn to stay sober. For others, however, outpatient treatment can be quite effective, and does not require the dislocation of going away for 30 or more days.

For me, treatment is a cooperative process. It begins with your own goals and expectations, and involves my input to help mold these goals into a workable plan. While I certainly have specific expertise in this area, this is your journey, and I respect your preferences in working with you. And if I do disagree with you, or think your plan isn't reasonable (or is dangerous), I'll certainly tell you so.